Q: For years I have had trouble holding my urine during sexual intimacy. I’m in my 40s and have had children and have a ridiculously small bladder. I’m always thinking about it and although my husband says it’s no big deal, I am so worried about being embarrassed that it’s holding me back. Is there any hope for me?

A: A study released this month from the University of Miami highlights this problem. Women who have had children, who are premenopausal or who have a small bladder capacity may be at increased risk for urinary problems. But those who begin to suffer incontinence suffer in their sexuality.

The study showed that when compared to women who have a leakage problem, women with an overactive bladder who were dry had improved desire for sexual activity, had better vaginal lubrication, achieved orgasms more frequently and reported higher sexual satisfaction. But for some women, even the thought of a compromise in hygiene can create performance anxiety that can be detrimental to her sexuality.

As urologists, we have fairly sophisticated tests to help us understand which women are more likely to have these problems. Once we can identify the problem, we can identify who is likely to be helped with medications, surgery or simple changes in diet or fluid intake. Once we can improve your bladder situation, you can focus on your lovemaking, not your urinary habits.